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Directory of Authors from the Journal and their last article.

Neil J BarberView Articles

Volume 17, Number 3Review Articles

Current Status of Hemostatic Agents and Sealants in Urologic Surgical Practice

Management Update

Sashi S KommuRobert McArthurAmr M EmaraUtsav D ReddyChristopher J AndersonNeil J BarberRaj A PersadChristopher G Eden

There has been a recent and near exponential increase in the use of hemostatic agents and sealants to supplement the rapidly evolving methods in the surgical management of urologic patients. This article reviews the use of hemostatic agents and sealants in current urologic practice. [Rev Urol. 2015;17(3):150-159 doi: 10.3909/riu0673] © 2015 MedReviews®, LLC

HemostasisTissue adhesionUrologic surgery

Neil MariadosView Articles

Volume 16, Number 3Review Articles

The Rationale for Optimal Combination Therapy With Sipuleucel-T for Patients With Castration-resistant Prostate Cancer

Treatment Review

Neal D ShoreRaoul S ConcepcionChristopher M PieczonkaVladimir MouravievNeil MariadosRobert B SimsMark Emberton

Immunotherapy encourages the recipient’s own immune response to destroy cancer cells, and current evidence suggests that immunotherapies may be most beneficial in early metastatic castration-resistant prostate cancer (mCRPC). Sipuleucel-T is the first therapeutic cancer vaccine to be approved by both the US Food and Drug Administration and European Medicines Agency for the treatment of asymptomatic or minimally symptomatic mCRPC. Combining immunotherapy with other treatments may have potent anticancer effects; cytoreductive therapies can release tumor antigens and promote a proinflammatory environment that could augment immunotherapies. However, some cytoreductive agents or coadministered drugs may be immunosuppressive. Understanding these interactions between different mCRPC treatment modalities may offer further potential to improve patient outcomes. [Rev Urol. 2014;16(3):122-130 doi: 10.3909/riu0637] © 2014 MedReviews®, LLC

Prostate cancerSipuleucel-TCombination therapy

Neil MendhirattaView Articles

Volume 16, Number 2Review Articles

Focal Laser Ablation for Localized Prostate Cancer: Principles, Clinical Trials, and Our Initial Experience

Treatment Update

Herbert LeporTed LeeNeil MendhirattaDan Sperling

Focal therapy of prostate cancer is an evolving treatment strategy that destroys a predefined region of the prostate gland that harbors clinically significant disease. Although long-term oncologic control has yet to be demonstrated, focal therapy is associated with a marked decrease in treatment-related morbidity. Focal laser ablation is an emerging modality that has several advantages, most notably real-time magnetic resonance imaging (MRI) compatibility. This review presents the principles of laser ablation, the role of multiparametric MRI for delineating the site of significant prostate cancer, a summary of published clinical studies, and our initial experience with 23 patients, criteria for selecting candidates for focal prostate ablation, and speculation regarding future directions. [Rev Urol. 2014;16(2):55-66 doi: 10.3909/riu0615] © 2014 MedReviews® LLC

Prostate cancerFocal therapyTargeted therapyLaser ablation

Nelson N StoneView Articles

Volume 20, Number 1Original Research

Transrectal Ultrasound–guided Versus Transperineal Mapping Prostate Biopsy: Complication Comparison

Transrectal ultrasound guided prostate biopsy • Transperieneal mapping prostate biopsy • Complications

Vladimir MouravievE David CrawfordVassilios M SkouterisPaul AranguaMarios Panagiotis MetsinisMichael SkouterisGeorge ZacharopoulosNelson N Stone

Herein, the authors compare morbidity in men who underwent both transrectal ultrasound–guided (TRUS) prostate biopsy and transperineal mapping biopsy (TPMB) at two institutions with extensive experience in both procedures. We also identified strategies and predictive factors to reduce morbidity for both procedures. In our study, 379 men from two institutions, of which 265 (69.9%) had a prior TRUS-guided biopsy, also had TPMB performed via a template with biopsies taken at 5-mm intervals. Men in the TRUS group had a median of 12 cores sampled whereas the TPMB group had 51.5 (range, 16-151). The median biopsy density was 1.1 core/cc prostate volume. Median age and prostate-specific antigen (PSA) level were 65 years (range, 34-86) and 5.5 ng/mL (range, 0.02-118). Of these men, 11 of 265 (4.2%) who had TRUS biopsy developed urinary tract infection compared with 3 of 379 (0.79%) of those with mapping biopsy. Infection was 14.8% in TRUS biopsy group with 13 or more cores versus 2.9% in those with 12 or less (OR, 5.8; 95% CI, 1.6-21.2; P = 0.003). No men developed retention after TRUS biopsy whereas 30 of 379 (7.9%) did following TPMB. Older age, larger prostate volume (PV), and higher core number were associated with retention. On linear regression only age (P = 0.010) and PV (P = 0.016) remained as significant associations. Men older than 65 years had 12.8% versus 3.9% (OR, 3.7; 95% CI, 1.6-8.4, P = 0.001) and PV greater than 42 cc had 13.4% versus 2.7% (OR, 5.7; 95% CI, 2.1-15.1) retention incidence. In the present study TPMB is rarely associated with infection (0.78%) but more commonly with urinary retention (7.9%). Men older than 65 years and with PV greater than 42 cc were at four to five times greater retention risk. Consideration should be given to discharging these men with a urinary catheter following TPMB. [Rev Urol. 2018;20(1):19–25 doi: 10.3909/riu0785] © 2018 MedReviews, LLC®

ComplicationsTransrectal ultrasound guided prostate biopsyTransperieneal mapping prostate biopsy

Nelson Neal StoneView Articles
Nenad DjakovicView Articles

Volume 13, Number 3Review Articles

Peyronie’s Disease: Nonsurgical Therapy Options

Treatment Update

Franklin E KuehhasNenad DjakovicPeter WeiblTosev GeorgiRalf Herwig

Peyronie’s disease (PD) is a fibrous inelastic scar of the tunica albuginea, leading to penile deformity, penile curvature, shortening, narrowing, and painful erections that subsequently lead to painful or unsatisfying sexual intercourse. No consensus exists yet on the ideal management of PD. This fact is a result of our limited knowledge of its etiology and causative factors. The acute presentation of PD is treated conservatively, and surgical approachesare only attempted if severe curvature, narrowing, or indentation persists for more than 1 year; PD stability exists for at least 3 months; curvature impedes sexual intercourse; and severe penile shortening occurs. This review focuses on new developments for conservative treatment strategies for PD. [Rev Urol. 2011;13(3):139-146 doi: 10.3909/riu0528] © 2011 MedReviews®, LLC

Peyronie’s diseaseNonsurgical therapyOral medicationIntralesionaltherapyExtracorporeal shock wave therapyIontophoresisPenile traction systems

Nermarie VelázquezView Articles
Nestor Gonzalez-CavidadView Articles
Niall CorcoranView Articles

Volume 13, Number 3Review Articles

Lower Urinary Tract Injuries Following Blunt Trauma: A Review of Contemporary Management

Management Review

Peter L RoyceMatthew F BultitudeJennifer KongRussell GruenAlex CatoNiall Corcoran

Lower urinary tract trauma, although relatively uncommon in blunt trauma, can lead to significant morbidity when diagnosed late or left untreated; urologists may only encounter a handful of these injuries in their career. This article reviews the literature and reports on the management of these injuries, highlighting the issues facing clinicians in this subspecialty. Also presented is a structured review detailing the mechanisms, classification, diagnosis, management, and complications of blunt trauma to the bladder and urethra. The prognosis for bladder rupture is excellent when treated. Significant intraperitoneal rupture or involvement of the bladder neck mandates surgical repair, whereas smaller extraperitoneal lacerations may be managed with catheterization alone. With the push for management of trauma patients in larger centers, urologists in these hospitals are seeing increasing numbers of lower urinary tract injuries. Prospective analysis may be achieved in these centers to address the current lack of Level 1 evidence.[Rev Urol. 2011;13(3):119-130 doi: 10.3909/riu0521] © 2011 MedReviews®, LLC

UrethraMultiple traumaRuptureUrinary bladderWounds

Niall M CorcoranView Articles

Volume 13, Number 2Review Articles

Contemporary Management of Renal Trauma

Management Update

Jennifer J ShoobridgeNiall M CorcoranKatherine A MartinJim KoukounarasPeter L RoyceMatthew F Bultitude

In the management of renal trauma, surgical exploration inevitably leads to nephrectomy in all but a few specialized centers. With current management options, the majority of hemodynamically stable patients with renal injuries can be successfully managed nonoperatively. Improved radiographic techniques and the development of a validated renal injury scoring system have led to improved staging of injury severity that is relatively easy to monitor. This article reviews a multidisciplinary approach to facilitate the care of patients with renal injury. [Rev Urol. 2011;13(2):65-72 doi: 10.3909/riu0512] © 2011 MedReviews®, LLC

NephrectomyRenal injuryBlunt traumaAngiogenesis

Nicholas SanfilippoView Articles

Volume 13, Number 1Case Review

Squamous Cell Carcinoma of the Prostate

Case Review

Samir S TanejaRena D MalikGeorge DakwarMatthew E HardeeNicholas SanfilippoAndrew B Rosenkrantz

"Squamous cell carcinoma of the prostate is a rare tumor, making up 0.5% to 1% of all prostate carcinomas. It is typically described as an aggressive cancer, with a median postdiagnosis survival of 14 months. Presented here is a case of primary squamous cell carcinoma of the prostate, with a complicated presentation of metastatic disease. Due to the extent of the patientís disease, he was treated with palliative radiation therapy using a four-field technique (AP/PA and left and right lateral fields) with 18 mV photons prescribed to the 100% isodose line. The prescription dose was 4000 cGy in 16 fractions of 250 cGy per fraction. No definitive treatment of squamous cell carcinoma of the prostate exists but varying approaches including surgical intervention, chemotherapy, and radiation therapy have been implemented without durable response. However, multimodal treatments appear to be the most promising with longer durations of survival. [Rev Urol. 2011;13(1):56-60 doi: 10.3909/riu0494]"

Squamous cell carcinomaProstate adenocarcinomaLower urinary tractsymptomsMultimodal treatments

Nicholas VogelzangView Articles

Volume 8, Supplement 2Review Articles

Monitoring Response, Prediction Methodology, Staging, and Imaging in Prostate Cancer

16th International Prostate Cancer Update

David PomerantzNicholas Vogelzang

The predictive values of various tests and examinations are assessed as they relate to prostate cancer progression and treatment. The usefulness of post-treatment biopsy specimens is greatest 2 years after radiation therapy completion. Gleason grading is not reliable in the setting of hormonal ablation therapy. For patients with extracapsular extension, the survival curves separate depending on whether positive or negative surgical margins are obtained. Prostate-specific antigen doubling time is increasingly used as an indicator of disease recurrence after local therapy and prostate cancer–specific survival. [Rev Urol. 2006;8(suppl 2):S30-S34]

Prostate cancerImmunotherapyProstate-specific antigenPredictive modelingProstate-specific antigen doubling time

Nicola MacchioneView Articles

Volume 15, Number 4Review Articles

Intracavitary Immunotherapy and Chemotherapy for Upper Urinary Tract Cancer: Current Evidence

Systematic Review

Luca CarmignaniRoberto BianchiGabriele CozziNicola MacchioneCarlo MarenghiSara MelegariMarco RossoElena TondelliAugusto MaggioniAngelica Grasso

A review of the literature was performed to summarize current evidence regarding the efficacy of topical immunotherapy and chemotherapy for upper urinary tract urothelial cell carcinoma (UUT-UCC) in terms of post-treatment recurrence rates. A Medline database literature search was performed in March 2012 using the terms upper urinary tract, urothelial cancer, bacillus Calmette-Guérin (BCG), and mitomycin C. A total of 22 full-text articles were assessed for eligibility, and 19 studies reporting the outcomes of patients who underwent immunotherapy or chemotherapy with curative or adjuvant intent for UUT-UCC were chosen for quantitative analysis. Overall, the role of immunotherapy and chemotherapy for UUT-UCC is not firmly established. The most established practice is the treatment of carcinoma in situ (CIS) with BCG, even if a significant advantage has not yet been proven. The use of BCG as adjuvant therapy after complete resection of papillary UUT-UCC has been studied less extensively, even if recurrence rates are not significantly different than after the treatment of CIS. Only a few reports describe the use of mitomycin C, making it difficult to obtain significant evidence. [Rev Urol. 2013;15(4):145-153 doi: 10.3909/riu0579] © 2014 MedReviews®, LLC

ImmunotherapyChemotherapyBacillus Calmette-GuérinUpper urinary tractUrothelial cell carcinomaMitomycin C

Nicola PavanView Articles

Volume 17, Number 1Review Articles

Finding the Wolf in Sheep’s Clothing: The 4Kscore Is a Novel Blood Test That Can Accurately Identify the Risk of Aggressive Prostate Cancer

Diagnosis and Screening Update

Dipen J ParekhSanoj PunnenMASNicola Pavan

Better biomarkers that can discriminate between aggressive and indolent phenotypes of prostate cancer are urgently needed. In the first 20 years of the prostate-specific antigen (PSA) era, screening for prostate cancer has successfully reduced prostate cancer mortality, but has led to significant problems with overdiagnosis and overtreatment. As a result, many men are subjected to unnecessary prostate biopsies and overtreatment of indolent cancer in order to save one man from dying of prostate cancer. A novel blood test known as the 4Kscore® Test (OPKO Lab, Nashville, TN) incorporates a panel of four kallikrein protein biomarkers (total PSA, free PSA, intact PSA, and human kallikrein-related peptidase 2) and other clinical information in an algorithm that provides a percent risk for a high-grade (Gleason score ≥ 7) cancer on biopsy. In 10 peer-reviewed publications, the four kallikrein biomarkers and algorithm of the 4Kscore Test have been shown to improve the prediction not only of biopsy histopathology, but also surgical pathology and occurrence of aggressive, metastatic disease. Recently, a blinded prospective trial of the 4Kscore Test was conducted across the United States among 1012 men. The 4Kscore Test replicated previous European results showing accuracy in predicting biopsy outcome of Gleason score ≥ 7. In a recent case-control study nested within a population-based cohort from Västerbotten, Sweden, the four kallikrein biomarkers of the 4Kscore Test also predicted the risk for aggressive prostate cancer that metastasized within 20 years after the test was administered. These results indicate that men with an abnormal PSA or digital rectal examination result, and for whom an initial or repeat prostate biopsy is being considered, would benefit from a reflex 4Kscore Test to add important information to the clinical decision-making process. A high-risk 4Kscore Test result may be used to select men with a high probability of aggressive prostate cancer who would benefit from a biopsy of the prostate to prevent an adverse and potentially lethal outcome from prostate cancer. Men with a low 4Kscore Test result may safely defer biopsy. [Rev Urol. 2015;17(1):3-13 doi: 10.3909/riu0668] © 2015 MedReviews®, LLC

Prostate cancerBiomarkerScreeningHigh-grade prostate cancer

Nicole G FarhaView Articles

Volume 22, Number 3Case Review

From Radical to Partial Nephrectomy in the Setting of Solitary Functioning Kidney: Neoadjuvant Treatment of Renal Cell Carcinoma

David D WatsonNicole G FarhaK James KallailShaker DakhilA J Farha

Immunotherapy has revolutionized the treatment of metastatic renal cell carcinoma (RCC). This case evaluates the use of neoadjuvant immunotherapy for localized RCC in a patient with solitary functioning kidney. A retrospective chart review was conducted between September 2019 and January 2020 on a single patient. Before treatment, the tumor was 7 cm × 8 cm × 8.5 cm. The patient trialed nivolumab + ipilimumab then cabozantinib. The tumor shrunk to 6.3 cm × 5.5 cm and was removed via partial nephrectomy. This case demonstrates the efficacy of immunotherapy in neoadjuvant treatment of RCC. Expansion of guidelines could allow for patients with RCC to undergo partial nephrectomy. [Rev Urol. 2020;22(3):126-129] © 2020 MedReviews®, LLC

Renal cell carcinomaImmunotherapyNeoadjuvant immunotherapySolitary kidney

Nicole SmithView Articles

Volume 23, Number 3Editorial

The Specialty Networks Localized to High-Risk Biochemically Recurrent Prostate Cancer Patient Playbook

Gautam JayramKatie GrantJayme NalleyNicole Smith

Prostate cancer (PCa) is the second-leading cause of cancer death among men in the United States. The American Cancer Society estimates that more than 299 010 men will be diagnosed with PCa in 2024, with more than 35 250 PCa-associated deaths.1 It is estimated that of those patients treated for localized PCa, 30% to 35% will experience biochemical recurrence (BCR), which further increases the risk of PCa death. Although multiple definitions have been proposed, BCR is generally present when a man has a persistently rising prostate-specific antigen (PSA) value after definitive local therapy (Table 1) in the absence of radiographic evidence of metastatic disease. This definition has evolved and will continue to develop, with advances in genomics, next-generation sequencing, and digital pathology.

Nicole WakeView Articles
Nicolette JanzenView Articles
Nihal MohamedView Articles

Volume 13, Number 4Review Articles

A Review of Focal Therapy Techniques in Prostate Cancer: Clinical Results for High-Intensity Focused Ultrasound and Focal Cryoablation

Treatment Review

Colin IbertiNihal MohamedMichael Palese

The advancement of focal therapy technology for the treatment of prostate cancer (PCa) is emerging as an option for a middle ground between radical therapies and active surveillance for individuals identified with localized, low-grade PCa. Two promising techniques are high-intensity focused ultrasound (HIFU) and focal cryoablation. Both focal cryoablation and HIFU show promise, but additional prospective trials are necessary before any definitive conclusions can be made on either method’s viability. [Rev Urol. 2011;13(4):e196-e202 doi: 10.3909/riu0540] © 2011 MedReviews®, LLC

Prostate cancerHigh-intensity focused ultrasoundFocal cryoablation

Nikhi P SinghView Articles

Volume 22, Number 1Review Articles

Obesity and Its Impact on Kidney Stone Formation

Disease State Review

Dean G AssimosKyle WoodWilliam PooreCarter J BoydNikhi P SinghBarbara Gower

The prevalence of obesity is rising and places this cohort at risk for developing kidney stones. Some of the pathophysiologic responses that link obesity and kidney stone formation have been identified. Herein, we review the involved mechanisms driving this relationship and the impact of various weight loss strategies on kidney stone risk. [Rev Urol. 2020;22(1):17–23] © 2020 MedReviews®, LLC

ObesityKidney stonesDiabetesMetabolic syndromeHypertensionWeight managementObese animal models